Posted on 04/23/2005 9:15:39 AM PDT by bitt
As of 20 April, the Ministry of Health in Angola has reported 266 cases of Marburg haemorrhagic fever. Of these cases, 244 were fatal. In Uige Province, which remains the epicentre of the outbreak, 253 cases, of which 233 have been fatal, were reported as of 21 April.
Assessment of the outbreak
The international response to the outbreak in Angola began one month ago, on 22 March. The features of Marburg haemorrhagic fever, and the conditions in Angola, have been an extreme test of international capacity to hold emerging diseases at bay. The outbreak in Angola is the largest and deadliest on record for this rare disease, which is presently showing a case fatality rate higher than 90%. For comparison, outbreaks of the closely related Ebola haemorrhagic fever have shown mortality rates ranging, according to the virus strain involved, from 53% to 88%. The only other large outbreak of Marburg, in the Democratic Republic of Congo from 1998 through 2000, had a case fatality of 83%.
Two factors make the rapid detection of outbreaks of Marburg haemorrhagic fever difficult: the extreme rarity of this disease and its similarity to other diseases seen in countries where deaths from infectious diseases are common. Neither the source nor the date of the initial cases in Angola can be presently identified with any certainty.
The number of cases began increasing in February and then, more dramatically, in March. On 21 March, Marburg virus was detected in patient samples sent to the Centers for Disease Control and Prevention in Atlanta (USA), and WHO assistance was requested by the Ministry of Health in Angola. The operational response began the following day. As known from extensive experience with outbreaks of other viral haemorrhagic fevers, including Ebola, outbreaks of Marburg can be brought to an end using classic public health interventions. In theory, the measures needed to end the Angolan outbreak are few in number and straightforward in nature. Rapid detection and isolation of patients, tracing and management of their close contacts, infection control in hospitals and protective clothing for staff work to interrupt chains of transmission and thus seal off opportunities for further spread.
Such straightforward measures are complicated by the distinct features of this disease. The sudden onset, dramatic symptoms, and rapid deterioration of patients, and the absence of a vaccine and effective treatment, invariably incite great anxiety in affected populations. This anxiety, in turn, can interfere with control operations, especially when communities begin hiding cases and bodies because of suspicions about the safety of hospitals.
In the current outbreak, such suspicions are understandable. Very few patients with laboratory-confirmed Marburg haemorrhagic fever have survived; most hospitalized patients have died within a day or two following admission. For affected communities, staff from the mobile teams, fully suited in protective gear, are seen as taking away relatives and loved ones who may never again be seen alive.
WHO staff in Uige have today reported further signs that community attitudes are improving, though hostility towards the mobile teams remains of concern in one area known to have recent cases and deaths. Efforts to sensitize affected communities are continuing, with local volunteers supported by Portuguese-speaking experts from Brazil and Mozambique.
Conditions in Angola – a country weakened by almost three decades of civil unrest – have presented additional challenges. Supplies of water and electricity are intermittent, also in health care facilities. Weakened infrastructures, including those for communications and transportation, are another problem. Yesterday, the WHO office in Uige was informed of a death in another municipality, but was unable to collect the body for safe burial because of poor road conditions.
Fortunately, spread of the disease beyond Uige Province, located in the interior of the country, has been limited. Of the 266 cases and 244 deaths, 197 cases and 183 deaths occurred in Uige municipality. Other municipalities in Uige Province account for an additional 56 cases and 50 deaths.
WHO believes that the risk of international spread is low. No foreign nationals, with the exception of those involved in the direct care of patients, have been infected. There is no evidence that people can spread the virus before the onset of symptoms. Shortly after symptom onset, patients become rapidly and visibly very ill
WHO is optimistic that the outbreak can be controlled if present activities continue with sufficient vigour. All the essential containment measures are being applied with extensive international support, including more than 60 international staff drawn from institutions in the Global Outbreak Alert and Response Network, and the cooperation of national authorities and experts.
Tools and methods developed during international responses to outbreaks of other diseases have all been brought to bear on the present outbreak, and the success of this collaborative effort has surpassed initial expectations. Needs, which have ranged from satellite telephones and hand-held radio sets to vehicles, protective equipment, disinfectants, and specialized staff, have been rapidly communicated and immediately met.
WHO and its partners are nonetheless prepared and organized to continue the outbreak response for several additional months, if this is needed. An important present goal is to transfer skills and responsibilities for outbreak response to national staff, and training efforts are under way with this goal in mind.
I don't think it's burned itself out. More likely, the locals are taking care of of their family members at home so they don't "disappear" at a local, government-run hospital.
Poor sanitation
Poor personal hygiene
Unprotected sex
Hot climates
Raw sewage and human waste/excrement in rivers or in fields
Low vaccination rates for several diseases (even resistance to free vaccines from the West)
Largely promiscuous societies
Little pest control (Flies, mosquitoes, fleas, rats......)
Oh- a new lethal disease just popped up! Are we supposed to be surprised? That whole Continent is like a Petri dish. Ebola, AIDS, Marburg……brace yourself, I’m going out on a limb here. We’ll see more diseases like this in the future!
Red6
I don't think we've seen the last of this one yet.
These numbers don't seem right.
It must be hell to for the Angolan Ministry of Hotels and Tourism.
#4 BTTT!
And then, do not forget, there was the evil empire!
[Whose rapidly migrating former slaves are much more a threat to US all than was ever posed by all of that monstrous evil's military!]
I don't think it's burned itself out. More likely, the locals are taking care of of their family members at home so they don't "disappear" at a local, government-run hospital.
I agree. I just can't fathom these numbers. No one is on-scene to tell what is actually happening...I think I'll meander over to Medecins Sans Frontieres to see if there's a new article there...
Like I said on a previous thread, when they changed the accounting methods, they changed everything.
Now the only cases that get counted are ones where there is absolute lab confirmation.
So if one person dies, and one test is done, or ten people in the same family die and one test is done, it counts as one case.
Period.
So they could make it go away. Just don't do any tests.
It's too hot.
Break the thermometer.
There! That's better!!!
I went to the BBC, I went to MSF, Reuters, I went to the WHO, I went to Recombinomics, I went to Curevents, I went to the US Embassy Angola web site, I went to google, I went to Yahoo, and I cannot find ANY new information about the outbreak anywhere.
I'm wondering if there will be more information released the first of the week.
It looks there is NO information about the outbreak leaving Angola by any route.
Surely, if there were good news, it would be out...ALL the case counts are old and cold.
I've been watching since November or so, when it was first identified, it's not unusual for the reports to not appear over the weekend.
But the last ten days or so have been real quiet, and I agree, if there was good news, they'd be blasting it from the rooftops.
Oh, and by the way, the US Embassy in Angola is still advising Americans against travel there (and has been since March 25 at least), because of the Marburg outbreak. That has not changed.
Interesting.
One possible explanation is that the WHO and Angolan authorities are in a stalemate.
This outbreak is somewhat counter-intuitive. For most epidemics, the number of current cases is a large fraction (much more than half) of the total cumulative cases (cumulative = active cases + fatalities + recovereds). We tend to think about outbreaks that way.
However, for this case, the number of active cases is very small, about 10%. This week, it is about 20 cases. Last week it was about 20. When we first started looking at this it was about 15.
The point is, these are small numbers. It is interesting to consider that. It means that the epidemic is maintained by very few actives.
On the good side, if you know the 20 active cases, you isolate them and the epidemic is over. It might be possible with only 20 cases.
On the bad side, if one of those 20 gets out and infects just a few more, then the epidemic could explode. Consider, one person infecting 10 others in a day. Not an implausible possibility.
I susptect that the WHO knows this. I suspect that they think/hope they have it under control, but they know that if this gets out, the growth is still potentially explosive.
A week ago, I thought this past week would give us the information we need, in order to know the future of this outbreak.
If you had told me that the numbers would be "administratively re-classified" and that no new information would be released for 10 days, I wouldn't have believed it could be possible.
I sort of agree with your post, but then I remember the story of the pregnant woman near term with Marburg who left the hospital in the company of 4 or 5 people in a jeep and was never heard from again...and I read again the information from Doctors Without Borders from the 18th--five days ago--saying that basic supplies, education of the public, more medical personnel, training of current Angolan medics, etc. were all needed before they could hope to contain the outbreak--and I wonder....
Can Marburg fizzle out? REALLY????
There sure appears to be a media blackout on the Marburg virus. In this case I do not believe that no news is good news. It's hard to believe the virus just stopped dead in its tracks. All we can do at this point is wait and see if Marburg virus escapes from Amgola because if or until it does, this story is virtually dead.
Certainly it is still expanding. But it seems as though it is not as virulently infective as, say, malaria.
Even if we found the natural vector, what are the odds we could exterminate or eradicate simething in tropical Africa?
Not good. Probably not even remotely good.
I don't think it's a media blackout, in this case I think it's an Angolan blackout, frankly.
It certainly seems improbable.
Given that only about 20 cases can keep this thing going, it seems awfully infectious.
However, the counter argument was posted by someone else. If this thing is really that infectious, then the numbers should have exploded by now. Moreover, there should have been sufficient numbers that they would not have been able to hide it.
That hasn't happened either.
Given the mountains of contradictory information, I am concluding a basic stalemate, which results in a very slow exponential growth.
http://www.macleans.ca/topstories/news/shownews.jsp?content=w042377A
'April 23, 2005 - 21:11
Deadly virus outbreak being brought under control in Angola: UN
LONDON (AP) - Medical teams trying to stamp out the worst outbreak ever recorded of the deadly Marburg virus in Angola are beginning to bring it under control, as co-operation from stricken communities improves, the UN health agency said.
The virus, closely related to the feared Ebola virus, has caused hemorrhagic fever in 266 people and killed 244 of them since March, when the outbreak first came to the attention of health authorities.
As communities begin to understand the dangers of the virus, though, the number of new cases has dropped from an average of 35 a week to 15, the World Health Organization reported.
"This is good news but it doesn't mean the outbreak is over," said Dr. Fatoumata Diallo, the WHO representative in Angola, on Saturday.
"The chain of transmission is being broken as we speak. However, this is the most critical time now in the response," said Dr. Mike Ryan, the WHO's top outbreak specialist from the agency's headquarters in Geneva, Switzerland.
"Continuing and intensifying the effort is what we need to do now, not relax."
Efforts to educate communities about the disease, which is spread through direct contact with body fluids, and about the need to isolate patients both when they're ill and after death has been paying off, experts said Saturday. Medical teams also have tried to encourage co-operation by being more sensitive to villagers' fears about the health measures.
"The community response has improved very very much," said outbreak team leader, Dr. Nestor Ndayimiridje.
"Traditional leaders are coming to the office to report suspected cases or dead bodies. It was not like that two weeks ago."
Only one community remains hostile, he said.
Earlier in the outbreak, suspicious villagers threw stones at medical teams when they arrived to search for infected people and collect bodies. Families hid sick people and buried the dead secretly in traditional rituals that risked spreading the disease because they involved touching and bathing of the corpse.
The experts also have added a more human touch to their actions and interactions with the community, so villagers do not feel the teams have arrived as "sanitary police," said Dr. Pierre Formenty, the WHO's Marburg virus expert.
For example, the medical teams have lowered the plastic sheet fences around isolated wards, "so that people can come and see what we are doing," Formenty said.
"For them, the use of plastic is linked to death. If you have plastic around the place to isolate the ward, it shows maybe that you are going to kill them."
"We have tried to humanize the safe burial of the bodies, trying to involve the families to assist from a certain distance," Ndayimiridje said.
Doctors now refer to the isolation wards as treatment wards and allow one relative, fitted with a bioprotective suit, to visit their sick family members.
"We see when we go for the corpses that are reported to us that the families understand that the disease is transmissible. They have just one or two people taking care of the sick patient and the families know that they must not touch the bodies," Formenty said.
The number of new cases a week, though lower than before, is still "bizarrely" high at 15, he said.
"It's just a gut feeling that maybe things are going to be better."
Now that communities are reporting the cases, the team has started to focus on prevention measures.
Injecting of medicines could be playing a role in transmission and the experts have started a campaign warning of the dangers of reusing needles, Formenty said. The society in Uige, where most cases have occurred, favours injectable medicines over pills.
Experts also have started to focus on identifying and monitoring about 300 people who have come into contact with the sick or dead.
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